Case Report: Aberrant Left Vertebral Artery Management in Traumatic Transection of the Aortic Isthmus
Keywords:Aortic arch pseudoaneurysm, TEVAR, Aberrant left vertebral artery
Association of elective debranching and endovascular thoracic aortic repair (TEVAR) with aberrant left vertebral artery (AVA) revascularization and supra-aortic left carotid-subclavian bypass in post-traumatic pseudoaneurysm of the distal aortic arch are extremely rare procedures that can minimize unnecessary neurologic complications.
The patient was a 42-year-old man, stable, with a post-traumatic transection of the aortic isthmus, with origin of the AVA between the left common carotid artery (LCCA) and left subclavian artery (LSA). Preoperative planning and proper sizing of the stent-grafts were evaluated by means of computed tomography angiography (CT scan) images. The patient underwent a hybrid procedure that included TEVAR with landing zone 2, covering the origin of both the AVA and LSA and concomitant supra-aortic reimplantation of the AVA in the LCCA and left carotid-subclavian bypass combined with both ligation of the AVA and LSA proximally. Postoperative arteriography images confirmed the exclusion of the aneurysm and the patency of all arch vessels, including the AVA. No endoleak was reported.
Bavaria J, Milewski R.K., Baker J, Moeller P, Szeto W, Pochettino A. 2010. Classic hybrid evolv-ing approach to distal arch aneurysms: Toward the zone zero solution. The Journal of Thoracic and Cardiovascular Surgery Volume Volume 140 Number 6S S77-S80.
Czerny M, Weigang E, Sodeck G, Schmidli J, Antona C, Gelpi G, Friess T, Klocker J, Szeto W, Moeller P, Pochettino A, Bavaria J. 2012. Targeting Landing Zone 0 by Total Arch Rerouting and TEVAR: Midterm Results of a Transcontinental Registry. Ann Thorac Surg 94:84-9.
Dake MD, Miller DC, Mitchell RS, et al. 1998. The “first generation” of endovascular stent-grafts for patients with aneurysms of the descending thoracic aorta. J Thorac Cardiovasc Surg 116:689-703.
deSouza RM, Crocker MJ, Haliasos N, Rennie A, Saxena A. 2011. Blunt traumatic vertebral artery injury: A clinical review. Eur Spine J 20:1405-1416.
Gottardi R, Funovics M, Eggers N, Hirner A, Dorfmeister M, Holfeld J, Zimpfer D, Schoder M, Donas K, Weigang E, Lammer J, Grimm M, Czerny M. 2008. Supra-aortic Transposition for Com-bined Vascular and Endovascular Repair of Aortic Arch Pathology. Ann Thorac Surg 86:1524-9.
Heary RF, Albert TJ, Ludwig SC, et al. 1996. Surgical anatomy of the vertebral arteries. Spine 21(18):2074–2080.
Karacan A, Türkvatan A, Karacan K. 2014. Anatomical variations of aortic arch branching: evalua-tion with computed tomographic angiography. Cardiol Young 24:485-93.
Kim YK, Schulman S. 2009. Cervical artery dissection: pathology, epidemiology and management. Thromb Res 123(6):810-821.
Matsumura JS, Lee WA, Mitchell RS, Farber MA, Murad MH, Lumsden AB, et al. 2009.The So-ciety for Vascular Surgery Practice Guidelines: management of the left subclavian artery with tho-racic endovascular aortic repair. J Vasc Surg 50:1155-8.
Moss E, Khaliel F, Pressacco J, et al. 2013. Hybrid treatment of a complex aortic arch aneurysm with an aberrant left vertebral artery. J Card Surg 28:155-8.
Sepehripour A.H., Ahmed K., Vecht J.A., Anagnostakou V., Suliman A., Ashrafian H., Darzi A., Athanasiou T. 2011. Management of the left subclavian artery during endovascular stent grafting for traumatic aortic injury. A systematic review. Eur J Vasc Endovasc Surg 41:758-769.
Shinohara André Luis, Sangalette Beatriz Sobrinho et al. 2018. Anomalous origin of the vertebral artery J Morphol Sci 35:216-217.
Stiru O, Geana RC, Pavel P, Croitoru M, Boros C, Iovu I, Iliescu VA. 2017. Descending Thoracic Aortic Aneurysm Rupture Treated with Thoracic Endovascular Aortic Repair in a Patient with Pe-ripheral Artery Disease The Heart Surgery Forum 1895 21 (2).
Yoshitake A, Hachiya T, Okamoto K, et al. 2016. Postoperative stroke after debranching with tho-racic endovascular aortic repair. Ann Vasc Surg 36:132-138.
Zeeshan A, Woo EY, Bavaria JE, Fairman RM, Desai ND, Pochettino A, Szeto WY. 2010. Tho-racic endovascular aortic repair for acute complicated type B aortic dissection: Superiority relative to conventional open surgical and medical therapy. The Journal of Thoracic and Cardiovascular Surgery c Volume 140, Number 6S, S109-S115.
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).